Bemiparin versus Enoxaparin in the Prevention of Venous Thromboembolism among Intensive Care Unit Patients

Mohamed Sayed Abbas, Mohamed Sayed Abbas

Abstract

Background: Critically ill patients are considered a high-risk group for developing venous thromboembolism (VTE). Due to their impaired cardiopulmonary reserve, these VTEs may result in significant morbidity and mortality. In this study, we compared two types of low molecular weight heparin, enoxaparin, and bemiparin, as regards to their efficacy and safety in VTE prevention among Intensive Care Unit (ICU) patients.

Methods: This study was a prospective, randomized trial of 100 critically ill patients who are at high risk for developing VTE were included in this study and assigned to receive subcutaneous injections of either 3500 international units (IU) anti-factor Xa of bemiparin sodium or 40 mg of enoxaparin given once a day and patient were followed for 60 days after initiation of anticoagulant therapy for the development of documented deep venous thrombosis (DVT) using bilateral lower limb venous duplex, documented pulmonary embolism using computed tomography pulmonary angiography, and complications related to injectant anticoagulant.

Results: Confirmed DVT was observed in two patients (4%) in the bemiparin group compared with 10 patients (20%) in the enoxaparin group with P < 0.05. Confirmed pulmonary embolism (PE) was observed in seven patients (14%) in the enoxaparin group with no recorded cases of confirmed PE in the bemiparin group (P < 0.05). No deaths were recorded in either group. Adverse events such as ecchymosis or hematoma at the injection site were observed in one patient (2%) in the bemiparin group and eight patients (16%) in the enoxaparin group (P < 0.05). There was no significant statistical difference between both groups as regards other adverse effects and complications related to the injectant anticoagulant.

Conclusion: Bemiparin was superior to enoxaparin as a prophylactic anticoagulant for VTE in critically ill patients with less adverse local complications at the injection site. The study was registered on www.clinicaltrials.gov. Registration ID: NCT02795065. Registered June 8, 2016.

Keywords: Bemiparin; Intensive Care Unit; enoxaparin; low-molecular-weight heparin; venous thromboembolism.

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Flow chart of the trial

References

    1. Cade JF. High risk of the critically ill for venous thromboembolism. Crit Care Med. 1982;10:448–50.
    1. Fraisse F, Holzapfel L, Couland JM, Simonneau G, Bedock B, Feissel M, et al. Nadroparin in the prevention of deep vein thrombosis in acute decompensated COPD. The Association of Non-University Affiliated Intensive Care Specialist Physicians of France. Am J Respir Crit Care Med. 2000;161(4 Pt 1):1109–14.
    1. Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts WH. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med. 2001;161:1268–79.
    1. McCarthy ST, Turner JJ, Robertson D, Hawkey CJ, Macey DJ. Low-dose heparin as a prophylaxis against deep-vein thrombosis after acute stroke. Lancet. 1977;2:800–1.
    1. Kelly J, Rudd A, Lewis R, Hunt BJ. Venous thromboembolism after acute stroke. Stroke. 2001;32:262–7.
    1. McCarthy ST, Turner J. Low-dose subcutaneous heparin in the prevention of deep-vein thrombosis and pulmonary emboli following acute stroke. Age Ageing. 1986;15:84–8.
    1. Crowther MA, Cook DJ, Griffith LE, Devereaux PJ, Rabbat CC, Clarke FJ, et al. Deep venous thrombosis: Clinically silent in the Intensive Care Unit. J Crit Care. 2005;20:334–40.
    1. Schulman S, Beyth RJ, Kearon C, Levine MN. Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest. 2008;133(6 Suppl):257S–98S.
    1. Cosmi B, Palareti G. Old and new heparins. Thromb Res. 2012;129:388–91.
    1. Alalaf SK, Jawad RK, Muhammad PR, Ali MS, Al Tawil NG. Bemiparin versus enoxaparin as thromboprophylaxis following vaginal and abdominal deliveries: A prospective clinical trial. BMC Pregnancy Childbirth. 2015;15:72.
    1. Navarro-Quilis A, Castellet E, Rocha E, Paz-Jiménez J, Planès A Bemiparin Study Group in Knee Arthroplasty. Efficacy and safety of bemiparin compared with enoxaparin in the prevention of venous thromboembolism after total knee arthroplasty: A randomized, double-blind clinical trial. J Thromb Haemost. 2003;1:425–32.
    1. Zierler BK. Ultrasonography and diagnosis of venous thromboembolism. Circulation. 2004;109(12 Suppl 1):I9–14.
    1. Desciak MC, Martin DE. Perioperative pulmonary embolism: Diagnosis and anesthetic management. J Clin Anesth. 2011;23:153–65.
    1. Wittram C, Maher MM, Yoo AJ, Kalra MK, Shepard JA, McLoud TC. CT angiography of pulmonary embolism: Diagnostic criteria and causes of misdiagnosis. Radiographics. 2004;24:1219–38.
    1. Ibrahim EH, Iregui M, Prentice D, Sherman G, Kollef MH, Shannon W. Deep vein thrombosis during prolonged mechanical ventilation despite prophylaxis. Crit Care Med. 2002;30:771–4.
    1. Cook D, Crowther M, Meade M, Rabbat C, Griffith L, Schiff D, et al. Deep venous thrombosis in medical-surgical critically ill patients: Prevalence, incidence, and risk factors. Crit Care Med. 2005;33:1565–71.
    1. Dalen JE. Pulmonary embolism: What have we learned since Virchow? Natural history, pathophysiology, and diagnosis. Chest. 2002;122:1440–56.
    1. Balibrea JL, Altimiras J, Larruzea I, Gómez-Outes A, Martínez-González J, Rocha E Bemiparin Cooperative Study Group in Surgery for Cancer. Optimal dosing of bemiparin as prophylaxis against venous thromboembolism in surgery for cancer: An audit of practice. Int J Surg. 2007;5:114–9.
    1. Ciccone MM, Cortese F, Corbo F, Corrales NE, Al-Momen AK, Silva A, et al. Bemiparin, an effective and safe low molecular weight heparin: A review. Vascul Pharmacol. 2014;62:32–7.
    1. Robinson S, Zincuk A, Strøm T, Larsen TB, Rasmussen B, Toft P. Enoxaparin, effective dosage for Intensive Care patients: Double-blinded, randomised clinical trial. Crit Care. 2010;14:R41.
    1. Robinson S, Zincuk A, Larsen UL, Ekstrøm C, Nybo M, Rasmussen B, et al. Acomparative study of varying doses of enoxaparin for thromboprophylaxis in critically ill patients: A double-blinded, randomised controlled trial. Crit Care. 2013;17:R75.

Source: PubMed

Sponsorzy i współpracownicy

Warunki medyczne

Interwencje lekowe

3
Subskrybuj